En el Centenario de su Nacimiento]]> Description: A 17 years-old female with a history of aseptic meningitis and frontal abscess presented with headaches, nausea, vomiting, fever and bitemporal hemianopsia. MRI showed an hypointense sellar lesion with anular enhancement after contrast inyection on T1 weighted images.
Intervention: We performed a transsfenoidal approach. After oppening the dura purulent material was obtained from inside the sella. Pus was sterile. Pathology informed Rathke's cleft cyst abscess. The patient was treated with antibiotics. Outcome was favorable with hemianopsia improvement.
Conclusion: In this case with transsfenoidal surgery and the administration of antibiotics we achieved favorable results.]]> Methods: To make the anatomical descríptions we used formalín fixed cadaveríc specimens and authors recordings of the surgical procedures performed. The structures not visible wíth the endoscope (internal capsule, hypothalamus, etc.) were drawn on the photograms. Anatomical variations found in our surgical practice were also registered. Results: Care must be taken to avoid damaging important anatomical structures as the fornix, hypothalamus, basilar artery, etc. The most common anatomícal variation found was the opacity of th third ventricular flour. Others were: protrusion of the basilar tip, dysplastic basilar artery contacting the dorsum sellae and a bridging vessel crossing the third ventricle under the hypothalamic sulcus.
Conclusion: With the ETV it was possible to recognize the normal structures and its anatomical variations.]]> Description. 3 cases of arachnoid cysts were analyzed: 2 suprasellar (SS) (female 41 years old and fmales 19 years old) and 1 supracerebellar (SC) (male 49 years old). All had intracraneal hypertension. The SS cysts had visual and endocrine symptoms and the SC had a vermian syndrome. Diagnosis was made with MRI
Intervention. The cysts were endoscopillyfenestrated through thefrontal ventricle and Monro foramen. Postoperativelly MRI showed a reduction of the 3 cysts and the symptoms dissappeared. There was no morbility or mortality
Conclusion. The endoscopic treatment is an effective and safe alternative, to the microsurgical and derivative procedures. We recommend the endoscopic treatment of arachnoid cysts related to the third ventricle as the fírst election.]]> Presentación de una Serie de Casos]]> Methods. We present a series of 41 patients (31 males and 10 females) with 42 cranioplasties performed during the period 2001-2005. The etiology of the osseous defect was: traumatic, cerebrovascular, tumoral or infectious. The materials used were autologous bone, titanium, metylmetacrylate and porous polyethylene. Fixation was made using silk threads or titanium microplaques.
Results. The materials used were autologous bone in 5 cases, metylmetacrylate in 17 cases, bone and metylmetacrylate in 2 cases, titanium in 13 cases and porous polyethylene in 5 cases. The global rate of complications was 7.14%, which consisted in infection in 4.76% (one with autologous bone and one with metylmetacrylate and autologous bone and wound collection in 2.3% (with met ylmetacrylate).
Conclusion. Even though we believe the ideal graft is autoplastic, sometimes alloplastic materials must be used. Porous polyethylene has the lowest rate of complications and has very few disadvantages. Autologous bone is not without complications; in our series two patients suffered infections with this material. To prevent complications the timing between craniectomy and cranioplasty was very important, mainly when there has been a previous infection.]]> Description: A 29 years-old male complained of acute shoulder pain with supraspinosum and infraspinosum muscles atrophy. Presumptive diagnosis was suprascapular nerve compression at the scapular notch.
Intervention: We performed the operative release through a supraspinous approach. Postoperative outcome was followed by pain disappearance and muscle volume recuperation.
Conclusion: Suprascapular nerve compression at the scapular notch is an infrecuent chronic syndrome. In this case supraspinous release had a favorable outcome. Key words: suprascapular nerve, chronic nerve compression, supraespinosus muscle. Palabras clave: compresión neural crónica, músculo supraespinoso, nervio supraescapular]]> Method: We analyzed the clinical records of the first 4 operated cases.
Results: Sawamura's technique showed an important reduction of the dysarthria and dysphagia associated with the hipoglossal nerve section. The present cases were operated by neurosurgeons not specifically trained in temporal bone drilling (first two cases), and with the presence of an otologyst (second two cases). Operative time was reduced in this last circumstance. We had no complications.
Conclusion: In spite that the performance of this technique was longer and technically demmanding, it was possible to diminish the alterations caused by the complete hipoglossal nerve section without any significant increase in morbidity.]]> Methods: We studied 63 cases with SCC treated with PRT between 01/ 1994-12/2003. The design was prosctive and observational. Patients under 21 years and/or other treatment previous to PRT, mo2re than one primary site and/or other conditions with associated neurological impairment were excluded. Age, sex, primary site, metastatic status, date and diagnostic method of PRT and SCC, level and number of SCC events, clinic-neurological parameters pre2vious/ post-PRT, delay between diagnosis/ treatment, Karnovsky performance status (KPS), motorfunction, pain, sensitive function and sphincter control were assessed. Variables were distributed in three levels: improvement/unchanged/ worsening. Three different PRT schedules were recorded according to dose-per-fraction (200cGy, 250cGy, _,?400cGy). Tumor histology was divided in favorable/ intermediate/ unfavorable. Post-PRT and global survival were assessed. Survival post-PRT was stratified into <6, 6-12, 12-24 and >24 weeks. x2, Fisher or Kruskall-Wallis tests were used to state statistical significance. p<0.05 was considered significant. Results: Global survival: 38.5+/-5.6 weeks. 86.8% had pain relieve after PRT. Two patients had a second episode of SCC. The variables which conditioned both the functional evolution and survival after treatment were the neurofunctional status (p=0.01) (p=0.04), the ambulatory status before treatment (p=0.002) (p=0.04) and the time from the beginning of the motor deficit until the start of PRT (p=0.01) (p=0.01) respectively. The variables which significantly conditioned only the functional evolution were KPS (p=0.000001), sphincter control (p=0.0003) and sensitivefunction (p=0.000001), not affecting survival after PRT, which was related to pain(p =0.03).
Conclusion: Time and degree of neurofunctional deficit that a patient suffers until receiving PRT will significantly affect both functional evolution and survival time.]]> Conclusion: In this case anterior cervical surgery and radiotherapy was an appropiate treatment for metastasic cervical pheochromocytoma.]]> Description: A young woman 18 years old presented with a syndrome of spinal cord compression, spleenomegaly, peripheral pancytopenia and coagulopathy. Hematological investigations established the diagnosis of APL. In this case the possibility of a GS as the cause of the neurological syndrome was supposed. Malignant lymphoma and other solid tumors where considered as differential diagnosis. Bone marrow puncture, coagulogram immunophenotyping, cytogenetics and molecular investigations, confirmed the diagnosis of APL.
Intervention: The patient was not operated due to her severe hematological condition. Neurological improvement was rapid soon after medical therapy was institutedfor the APL. Conclusion: If GS is suspected as the cause of spinal cord compression, the decompression must be considered only when the hematological diagnosis is not clear and the patients are in good clinical condition. In those patients with APL medical antileukemic therapy should be considered as the first option.]]> Description: A 46 years-old worker who had a L4/ L5 discectomy, suffered recurrent right ciática after 2 months. The MRI showed a recurrent disc herniation.
Intervention: The patient was treated with 10 sessions of percutaneous oxygen-ozone therapy injection in the lumbar spine. Paravertebral injections consisted on the administration of 60 mlofoxygen-ozone at a concentration of 30 mcg / ml, applied in 4 different sites of the paravertebral area over the pathological level. We did not use anesthetics or steroids. Conclusion: This technique was simple, had no risks and offered to the patient an option to surgery.]]> Methods: Between April 2001 and March 2005 we performed a suspended laminotomy in 10 cases with lumbar stenosis. All patients were evaluated with pre and postoperative plain films and MRI, and 7 of them had also a lumbar CT scan. Pain measurement was done with the Robinson scale.
Results: All patients improved their symptoms. The increase of the diameters of the spinal canal was meassured by MRI, and the symptomatic improvement by the Robinson and Herkowitz scales.
Conclusion: Suspended laminotomy allows a wide and simmetrical decompression of the spinal canal similar to laminectomy, but without its morbidity or its potential disadvantages.]]> Description: A 6-years old girl was admitted with neck pain and torticollis afterfalling on her back. Radiographs of the cervical spine showed no abnormality. Computed axial tomography (CAT) of the upper cervical spine showed a fracture of the anterior arch of the atlas.
Intervention: She was placed in afirm cervical collar and was instructed to reduce her daily physical activities. A new CAT 3 months later showed fusion at the fracture site. Conclusion: On plain radiographs fracture of the anterior arch of the atlas may remain occult. The proper diagnosis depended on further radiologic investigations, specially CAT. Immovilization with a firm cervical collar was the treatment of choice.]]> Description A 54-year-old woman was admitted because of T12-L1 disc herniation. Through a 2-cm long paramedian skin incision a transpedicular endoscopic approach was performed with total discectomy. The postoperative course was uneventful. Conclusion The initial experience suggests that the endoscopic transpedicular approach may be used to remove athoracic disc herniation.]]> Intervention: he was treated medically and after 30 days the patient was asymptomatic. A new MRI showed no discal hernia.
Conclusion: In a patient with a cervical extruded disc, the nonsurgical treatment should be considered as an option.]]> Results: In L3-L4 and L4-L5 the cleft was located in the right at 15.90 mm (±5.82) and 18.34 mm (±7.42) respectively from the midline and in the left at 16,30 ± 5,67 and 19.33 ± 7,24 respectively for the midline.
Conclusion: The intermuscular cleft location from the midline on MRI showed great variability.]]> Intervention. Evacuation was performed in both, with an uneventful outcome. Control CAT showed cerebral re-expansion and no hematoma.
Conclusion. SSH responded well to therapy and as we did notfind their cause we prefer to call them idiophathic.
Key words: etiopathogeny, subdural hematoma, surgical treatment.]]> Methods: Patients with CSH operated between 1999 and 2005 were analyzed. Variables examined were: sex, age, clinical presentation, history of traumatic brain injury (TBI), time elapsed between the TBI and the onset of symptoms, the surgical technique used, time of drainage, hospital stay and complications.
Results: A series of 47 operated patients were analyzed. Sixteen patients were females and 31 were males. Median age was 79 years. History of TBI was present in 36 patients, the median time elapsed between the TBI and the clinical presentation was 45 days. Clinical presentation: intracranial hypertension (ICH) in 27,7% of cases, focal signs in 34% and a mixed clinical presentation (ICH + focal signs) in 34% of cases. Surgical technique used: burr holes in 93,6%, craniotomy in 4,3%, craniectomy in 2,1% mean drainage time was 2 days. Mean hospital stay was 5 days. Complications: overall morbidity was 14% and mortality 2.2%
Conclusion: We did not found any difference in the number of complications, drainage time and hospital stay among the surgical techniques used. The preferred surgical technique will depend on each particular case and the experience of the treating neurosurgeon.]]> Description: a 3 years-old femalepatient with Down syndrome presented an acute left faciobrachiocrural hemiparesis. CT scan and MRI showed cerebral ischemic areas. Cerebral angiography showed an obstruction at the intracranial right carotid artery bifurcation with collateral circulation through multiple basal arterial anastomosis compatible with moyamoya disease.
Intervention: we performed an encephalo-myo-arterio-synangiosis using the combined technique of Matsushima. Postoperative outcome was uneventful. Paresis inproved completely. Postoperative angiography performed 12 months after showed a good revascularization.
Conclusion: in this case of moyamoya disease the Matsushina technique performed had a low morbidity and a good outcome.]]> Description. 2 cases (F-70 years old/ F- 68 years old) of DCCF previously incompletely treated with the transarterial and trans vein femoral approaches, had symptoms persistence. Both were a Barrow type D DCCF.
Intervention. The superior ophthalmic vein was microsurgically exposed and catheterized. With the use of a microguide the DCCF were embolized with platinum coils. DCCF were completely obliterated with symptoms dissappearence.
Conclusion. The ophthalmic approach through the superior ophthalmic vein was an
alternative to the traditional neuroradiologic approaches.]]> Methods: We analyzed retrospectively 29 cases operated with SGS. The stereotactic frame was fixed to the skull in 3 points in the tomography room and in all cases we obtained a CT scan with intravenous contrast. During surgery in order to avoid brain shifting, we never used mannitol and we tried to prevent spinal fluid drainage. Skin incisions, craniotomies, tumor removal, morbidity and hospital stay were analyzed. Results: In 24 cases we used a linear incision, and in all cases we used a small craniotomy that was not extended. We achieved total resection in 28 cases (96.55%) The morbidity associated with the procedure was 6.8% (2 cases). The average hospital stay was 3.8 days (3 to 8).
Conclusion: The resection of small brain lesions with the SGS, proved to be a very useful method for the treatment of different pathologies. It is a low cost and readily available method, with a positive cost-benefit relation.]]> Intervention: Complete removal was performed trought a left pterional approach. Pathology informed plasmocytoma. Outcome was uneventful. Afew days after she was discharged, the patient began with omalgia, left hemicraneal andfacial pain. A new MRI showed a new temporal intracranial lesion. Surgery was performed through the same approach. Outcome was again unevenful. She received radiotherapy.
Conclusion: Plasmacytoma must be considered at the moment of the diagnosis. It has to be differentiated from meningioma because it has a good response to radiotherapy.]]> Descripcion: A 22 years old male, complained of headaches, nausea and vomiting. The neurological examination was normal. An MRI showed a small oval tumor in the
quadrigeminal plate with a triventricular hydrocephalus.
Intervention: He was operated through a supracerebelar infratentorial approach. Complete resection was not posible due the to firm adhesions to vascular structures. Debulking and biopsy was performed. Pathology confirmed the diagnosis of lipoma. Conclusion: Intracranial lipomas are rare tumors, located more frecuently at the corpus callosum. Are seen commonly in males, between 10 at 19 years old. Only 50% are symptomatic, epilepsy is the most common form of presentation.]]> Intervention: A frontal craniotomy with extense tumor resection was performed, despite an intense bleeding. A postoperative hematoma that appeared in a control CAT was evacuated. The patient died several days after because of infectious complications. Pathology informed paraganglioma.
Conclusion: Sellar paragangliomas are extremely rare tumors. They can be confused with meningiomas or pituitary macroadenomas. The diagnosis is based on microscopical findings. Surgical management is recommended, and they should be operated through a craniotomy. The role of radiation therapy is unknown.]]> Description. A 31-year-old acromegalic woman was treated with lanreotide since september 2004. In march of 2005, she presented symptoms of transverse myelitis and 11 days later she began with headache, vomiting, visual disturbance, hyponatremia and hypoglycemía secondary to a pítuitary apoplexy. Diagnosis was made with MRI. Interbvention. We performed an early endonasal transsphenoidal surgery, to decompress the optic nerves, with a very good postoperative recovery. Myelitis was treated with metylprednisolon.
Conclusion. In this case urgent transsphenoidal surgery was the treatment of choice. Transverse myelitis and pituítary apoplexy were related probably to the treatment with lanreotíde.]]> Description: A 71 years old female was admitted to our institution after having seizures and a right crural paresis. An MRI showed 4 supratentorial lesions. Oncological screening was negative.
Intervention: MGM was diagnosed by stereotactic biopsy.
Conclusion: Histopathologic diagnosis by biopsy or surgery must be performed in all patients to differentiate MGM from other multiple cerebral lesions.]]> Methods: 20 cadaveric heads were studied and the anatomy of the diaphragma sellae was analyzed.
Results: The diaphragma sellae was composed of two layers of duramater. It presented a great variability in its opening. The average anteroposterior distance of its opening was 7.26 mm± 1.99 nun, and the average ofthe lateral distance of its opening was 7.33 mm± 2.79 mm. Conclusion: The variability of the diameter of the opening of the diaphragma sellae may explain why some pituitary tumors grow through the cavernous sinus and why others grow to the suprasellar region.]]> Reporte de un Caso y Revisión de la Literatura]]> Description: A 65 year-old woman with history of transnasal resection of a polipoid lesion followed by radiation therapy 20 years before the present interview, presented with a cranial base lytic tumor, voluminous cervical adenopathies and three intracranial tumors. Based on MRI and angiography, a presumptive diagnosis was made: direct extension of nasal tumor, intracranial distant metastasis and meningioma.
Intervention: Surgical treatment was performed on a stepwise basis, confirming the histology of ENB in the first two lesions. The third lesion, believed to be a radio-induced meningioma, was not resected at that time because we needed to initiate adjuvant therapy. Conclusion: Distant intracranial metastases of ENB, although extremely rare, must be suspected in the absence of mayor craniofacial surgery, mostly in cases of highly vascularized lesions irrigated by the external carotid system]]>